The loss of function in poliomyelitis palsies may be very great. In the upper extremity the shoulder is completely paralyzed and rarely the other joints are also immovable. Poliomyelitis of the lower extremi ties produces flaccidity of all the joints involved (especially of the ankle joint, "pendulum foot"); sometimes pes equinus with spasticity results owing to the preponderance of those muscle groups which are less se verely involved. When the paralysis is unilateral the power of walking is very incompletely restored and may be permanently lost. Many of these unfortunate creatures have to resort to the most bizarre methods of locomotion ("hand walkers").
The tendon reflexes in the domain of the affiketed muscles are di minished or abolished, although a reflex that is absent at first inay later reappear. The presence of a reflex, however, does not exclude the exist ence of spinal infantile palsy. For when the biceps, quadriceps, calf muscles (and the corresponding centres in the spinal cord) are intact, the triceps, patellar, and Achilles tendon reflexes may be preserved even if the other muscles of the same extremities are paralyzed. In fact, the reflexes in the leg may even be increased \ \ hen the arm on the same side is paralyzed, probably because of a slight degeneration of the amidal tract clue to extension of the primary inflammation to the region of the pyramidal tracts. The same explanation is probably applicable to the exaggeration of the Achilles tendon reflex when the knee jerk is absent, as sometimes occurs. The cutaneous nervous reflexes are present whenever the muscles concerned in their production are capable of reacting. Pain in the back or in the diseased extremity is common at t he beginning of the disease (symptoms of spinal cord irritation) and later disappear (Duquennoy). Disturbance.s of the bladder are rare, at least in infantile poliomyelitis and, when present, usually represent an early symptom of involvement of the lower segment of the spinal cord. According to Oppenheim the possibility of isolated poliomyelitis affect ing the muscles of the bladder and rectum (sudden occurrence of paraly sis of the bladder and rectum) must be borne in mind. It must not be forgotten that sphincter paralysis in the initial stage may be due to hyperpyrexia and hcbetude.
In addition to disturbances afTecting the mus.cular apparatus, the poliomyelitis is accompanied by a number of changes in the osseous system and in the skin, which are generally- designated trophic changes.
The skin of the affected extremities, particularly that of the legs, is cool to the touch, cyanotic and mottled like marble. There is a marked tendency to cutaneous diseases on the paralyzed side. While the eczem atous eruptions which occur might be ascribed to the continual wetting incident. to the use of electricity, other lesions resembling chilblains are probably due to vasomotor disturbances.
In early cases evidences of arrested development and a considerable degree of atrophy in the bones are quite frequently observed in the affected extremities, particularly the legs, and are readily demonstrated by means of the Rontgen rays. On the other hand, there are cases in which the diseased leg is longer than its fellow. Neurath offers for this peculiar condition the ingenious explanation that the child in such eases is probably rachitic and that the rachitis is less pronounced on the diseased side.
Flail joints, particularly in the shoulder, less frequently in the hip and knee, quite often result from paralysis of the mu,:eles which support the joint and, it need hardly be said, considerably add to the already existing functional disability of the diseased extremity.
Scoliosis and lordosis are sometimes observed when the muscles of the back are paralyzed.
Among unusual anomolies, mention may be made of a tendency to the secretion of sweat (IIigier) and hard cedema of the skin (scleroderrna, Oppenheim).
A few of these symptoms and their grouping in the various periods of the disease shows that in half way typical eases of myelitis three stages may be distinguished: 1. Initial Stage.—(a) This is often very brief and quite inconspic uous, without any striking symptoms (development of the paralysis over night); (b) or it may be accompanied by indefinite febrile symptoms which may last several days before the spinal paralysis manifests itself.
(c) In other cases marked nervous symptoms are present from the begin ning and point rather to a cerebral than to a spinal affection. It is possible that many of these eases terminate fatally with the picture of a meningitis, especially when the cervical portion of the cord is involved (Baumann), before the diagnosis of a spinal inflammation can be made.